Mechanical Complications of Myocardial Infarction
Riku Arai1, Daisuke Fukamachi1, Yasunari Ebuchi1
1Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Abstract:
In this retrospective observational study, we have examined the incidence, characteristics, and treatment of serious myocardial infarction (MI) -associated mechanical complications (MCs) occurring in Japanese patients in this era of percutaneous coronary intervention (PCI), focusing on frailty, nutrition, and clinical implication of surgery. Included were 883 patients who, having suffered an MI, had been admitted to Nihon University Hospital between January 2013 and April 2020. Fifteen (1.70%) of these patients had suffered a potentially catastrophic MC-ventricular free wall rupture (VFWR, n = 8), ventricular septal rupture (VSR, n = 6), or papillary muscle rupture (PMR, n = 1). Factors associated with the MCs were age, poor nutritional status, a high Killip class, delayed diagnosis of MI, a high lactate concentration, a low thrombolysis in myocardial infarction flow grade, and single-vessel disease. Thirty-day mortality among MC patients was 60% (9/15): 87.5% associated with VFWR, 33.3% associated with VSR and 0% associated with PMR. On adjusted multivariate analysis, occurrence of an MC was independently associated with 30-day mortality. Despite a high surgical risk (EuroSCORE II: 11.8 ± 4.7) with less frailty, 30-day mortality was lower among patients whose MC was treated surgically than among those whose MC was treated conservatively (40.0% versus 100.0%, respectively; P = 0.044).Our data suggest that surgical intervention can save patients with a life-threatening MI-associated MC and should be considered, if they are not particularly frail.
Insights
Serious mechanical complications (MCs) after myocardial infarction (MI) are rare but deadly. Surgical intervention, when feasible, can significantly reduce mortality in these high-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- Mechanical complications (MCs) following myocardial infarction (MI) represent a significant challenge in patient management.
- The incidence and impact of these complications in the era of percutaneous coronary intervention (PCI) require ongoing investigation.
- Factors such as frailty and nutritional status may influence outcomes in patients with MI-associated MCs.
Purpose of the Study:
- To determine the incidence, characteristics, and treatment outcomes of serious MI-associated mechanical complications (MCs) in Japanese patients.
- To investigate the role of frailty, nutrition, and surgical intervention in the management of these catastrophic events.
- To analyze the association between MCs and 30-day mortality.
Main Methods:
- Retrospective observational study of 883 patients admitted with MI between January 2013 and April 2020.
- Identification and analysis of 15 patients who developed mechanical complications: ventricular free wall rupture (VFWR), ventricular septal rupture (VSR), or papillary muscle rupture (PMR).
- Evaluation of factors associated with MC development and mortality, including frailty, nutritional status, and treatment strategies (surgical vs. conservative).
Main Results:
- The incidence of catastrophic MCs was 1.70% (15/883 patients).
- Ventricular free wall rupture (VFWR) had the highest 30-day mortality (87.5%), followed by ventricular septal rupture (VSR) (33.3%).
- Surgical intervention was associated with lower 30-day mortality (40.0%) compared to conservative treatment (100.0%) (P = 0.044), even in patients with high surgical risk but less frailty.
Conclusions:
- Myocardial infarction-associated mechanical complications are infrequent but carry a high mortality rate.
- Factors like advanced age, poor nutrition, and delayed diagnosis are associated with MC development.
- Surgical intervention should be strongly considered for patients with life-threatening MI-associated MCs, provided they are not excessively frail.
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